HomeMy Public PortalAbout9223 LEMON AVE_Plumbing__ 7BS.17 APPLICATION FOR PLUMBING PERMIT
DBS.I�'DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING
'J
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS �J
CASSATT O GRIFFIN.SUPT-OF BUILDING
LOCALITY
FOR AnWANT, TO FILL INNEAREST
CROSS ST
OWNE DISTRICT O._ GROUP ZONE I READY FOR INSPECTION
MAIL
ADDRESS
INDUSTRIAL '
CIT TEL. NO WASTE APPROVAL
PLUM INSPECTION RECORD
ADDRESS
CITY TE NO
LICEN N
NUMBER TYP&16F FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1 00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $100
KITCHEN SINK @ $1 00
DISHWASHER @ $1 00
LAUNDRY TUB OR TRAY @ $1 00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1 00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ I 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY OS ANG COUNTY AND STATE OF
CALIFORNIA OR THAT 1 THE GAL OWNER -OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL OPE 007
SIGNATURE �y -
OF PERMITTEE FINAL —Zi OMOM J
JOHN A. LAMBIE, COUNTY'ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG INSPECTOR
CN M • CASH
I,
6244 MAR21 3 2.00 m
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87
insure, gr a ce(tificate of Workers' Compensation Insurance, 76A667A
or a 5ertilied cbp�(S 3800, LLaabq� y� A, COUNTY OF LOS ANGELES DEPT. OF, PUBLIC WORKS
Policy No ompony �„`t L �'1 U`V
Certified copy is hereby furnished 1
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with th Im
ounty building inspe - ADDRESS
tion department.
NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date 10��TE 11poigonf WATER CLOSET �Q NEAREST
0 �J" ��
CERTIFICAOF EXEMPTION FROM WORKERS' BATH TUB CROSS ST
9_
COMPENSATION INSURANCESHOWER OWNER
(This section need not be completed if the work involved by
MAIL
the permit is for one hundred dollars ($100)or less.) Z LAVATORY /D ADDRESS n/ rr✓
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK * CIT TEL NO
so as to become subject to the W ers'Compensation PTWS DISHWASHER �e
�f CONTRACTOR C�
Date "L �A�plicont CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT •If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY L NO
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be S ATE //// LIC
deemed revoked ' WATER HEATER LICENSE NO �O"T77 CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO CePROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �0 G
(commencing C �—
with Section 7000) of Division 3 of the Business OUTLETS OVER O
and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION d
Z Z-��,
License Number Lic Class DATE U•
FINAL
ControctoqrMw. BY �=
❑ I am exempt under Sec. U
B.BP.0 for this reason Plan check fee y'
1010
Date PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE 1,1141,
SINGLE FAMILY Plan check applicant 4
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License
+_.•,Ra
Low for the following reason (Section 7031 5, Business and Address -- L '*(o IL
Professions Code)'
City Tel. No. _
❑ �. 17E' ;
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section ® s°�.'N,— ? ,�� L2 5
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
(Sec 3097, Civ C ).
Lender's Name -
a
Lender's Address _ !�► "
1 certify that I have read this application and state that the
above information is correct I agree to comply with all County
ordina and State laws regulating Plumbing, and hereby
a riz reprele tatives of this County to enter upon the
ov noon per, pection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ~
Signature of Perm Pre Date